Abstract

Background

It is important for patients with EGFR+NSCLC to receive both EGFR tyrosine kinase inhibitor (EGFR-TKI) and platinum doublet chemotherapy to achieve longer overall survival (OS). Up to the present, either treatment as first line setting is reasonable. However some previous prospective studies showed that patients with exon 21 L858R status EGFR+NSCLC may survive longer if they take platinum doublet chemotherapy as first line setting before EGFR-TKI. We examined which factors have an impact on OS most among patients with EGFR+NSCLC on a real-life setting.

Methods

A retrospective chart review was performed on 74 patients who had advanced stage or recurrent EGFR+NSCLC and received one or more regimen cytotoxic chemotherapy or EGFR-TKI at The Tazuke Kofukai Medical Research Institute Kitano Hospital between Jun 2007 and Jun 2015. We assessed the relationship for the status of EGFR mutation, the order of treatment steps, exist of brain metastasis, patient's characters and OS. Then the contributing factors for OS were analysed using Cox proportional hazards model.

Results

The characteristics of 74 patients with EGFR+NSCLC were as follows; EGFR mutation status exon 19 deletion/exon 21 L858R/minor mutation: number of patients (male) 37 (16)/32 (16)/5 (3), age 67.4 years-old, clinical or pathological stage of NSCLC: IIB/IIIA/IIIB/IV 1/7/4/62, ECOG-performance status(ECOG-PS): 0–1/2–4/unknown 65/6/3, existence of brain metastasis at the first time: 19, first line treatment: cytotoxic chemotherapy/EGFR-TKI 31/43, patients received both chemotherapy and EGFR-TKI/chemotherapy or EGFR-TKI only: 58/16. Median OS was 908 days for all patients. Most significant factor impacted on OS was ECOG-PS (p = 0.01), and there were no relations between OS and any other factors.

Conclusions

ECOG-PS is a most important prognostic factor for patients with EGFR+NSCLC on a real-life setting. Contrary to previous study, types of EGFR mutation and the order of treatment steps didn't impacted on OS.